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- Title
Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates.
- Authors
Everson, Jordan; Cheng, Audrey K.; Patrick, Stephen W.; Dusetzina, Stacie B.
- Abstract
Key Points: Question: Have states with greater increases in electronic prescribing of controlled substances (EPCS), which is intended to reduce opioid prescribing rates by reducing fraud and facilitating decision support, experienced greater reductions in opioid prescribing? Findings: In this longitudinal analysis of Surescripts reports on the use of EPCS and Center of Disease Prevention and Control opioid prescribing rate maps, increasing the use of EPCS by 10 percentage points was associated with 2 more opioid prescriptions per 100 persons and 0.8% more morphine milligram equivalents. Meaning: The EPCS has not been associated with reductions in opioid prescribing rates, and achieving benefit may require greater integration and effective presentation of data. Importance: The majority of US states have passed mandates requiring the use of electronic prescribing of controlled substances (EPCS) as a tool to reduce rates of opioid prescribing. It is not known whether increasing use of EPCS will have the intended effect. Objective: To assess the association between use of EPCS and trends in opioid prescribing. Design, Setting, and Participants: In this retrospective, longitudinal cohort study of all patients and prescribers in the 50 US states and the District of Columbia from 2010 to 2018, changes in state-level use of EPCS and concurrent changes in opioid prescribing in each state are described. Then the association between changes in the use of EPCS and opioid prescribing are estimated using state and year fixed-effects models that include covariates for policy change and state demographic change. Data Analysis was performed on May 5, 2020. Main Outcomes and Measures: The proportion of controlled substances in each state prescribed using EPCS based on opioid prescriptions per 100 persons and morphine milligram equivalents (MME) of opioids. Results: In 2018, the population-weighted percent of opioids prescribed using EPCS was 27%, up from 0% as of 2013. National rates of opioid prescriptions decreased from 78 prescriptions per 100 persons in 2013 to 53 in 2018. Over the same period, there was a decrease from 64 071 MME per 100 persons in 2013 to 40 906 MME per 100 persons in 2018, representing 36% of the 2013 level. By 2018, EPCS increased to 69.4% in states with mandates for its use and 23.6% in states without mandates. In multivariable models, a 10 percentage-point increase in the use of EPCS was associated with an additional 2 prescriptions per 100 persons (95% CI, 1.3-2.8) and a 0.8% (95% CI, 0.06%-1.5%) increase in MME per 100 persons. Conclusions and Relevance: These data suggest that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Opioid prescribing is associated with a variety of social and public health factors, and thus, despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing. Policy makers should consider levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions. This retrospective, longitudinal cohort study assesses the association between use of electronic prescribing of controlled substances and trends in opioid prescribing.
- Subjects
WASHINGTON (D.C.); UNITED States; CONFIDENCE intervals; DRUG prescribing; LONGITUDINAL method; MULTIVARIATE analysis; NARCOTICS; REGRESSION analysis; RESEARCH funding; STATISTICS; PHYSICIAN practice patterns; DATA analysis; MULTIPLE regression analysis; CONTROLLED substances; RETROSPECTIVE studies; DATA analysis software; STATISTICAL models; DESCRIPTIVE statistics
- Publication
JAMA Network Open, 2020, Vol 3, Issue 12, pe2027951
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.27951